NPIMap

Organization Active NPI

Prima Medical Foundation

  • Orthopaedic Surgery Physician
  • Novato, CA
National Provider Identifier
1639366586
Registry record updated Aug 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
G30247 Issued in CA
Legal business name
PRIMA MEDICAL FOUNDATION
Practice address
165 Rowland Way Ste 100
Novato, CA 94945-5055
Phone
(415) 898-4211
Fax
(415) 898-9252
NPI assigned
Sep 25, 2007
Last updated
Aug 1, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dennis Mondragon
Title
Ceo
Phone
(415) 884-1840

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207X00000X G30247 CA Primary

Addresses

Primary practice location

165 Rowland Way Ste 100
Novato, CA 94945-5055

Mailing address

4 Hamilton LNDG
Suite 100
Novato, CA 94949-8256
Phone (415) 884-1840

National Provider Directory

National Provider Directory
Tax ID family
Prima Medical Foundation Sebastopol19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

Organizations that report the same tax identification number in the National Provider Directory.

View all 18

Ownership & related parties

Subparts reporting this organization as parent 19

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343779200000",
    "number": "1639366586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 HAMILTON LNDG",
            "address_2": "SUITE 100",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949498256",
            "telephone_number": "415-884-1840",
            "fax_number": "415-884-3510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 ROWLAND WAY STE 100",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949455055",
            "telephone_number": "415-898-4211",
            "fax_number": "415-898-9252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMA MEDICAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2012-08-01",
        "status": "A",
        "authorized_official_last_name": "MONDRAGON",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "415-884-1840"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "G30247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Novato, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.